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HTH 231 Mid-Term Study Guide

by: Kristin Coggins

HTH 231 Mid-Term Study Guide HTH231

Marketplace > James Madison University > Health Sciences > HTH231 > HTH 231 Mid Term Study Guide
Kristin Coggins
GPA 3.5

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This covers every unit that will be covered on the mid-term
population health determinents
Dr. Mary Ott Walter
Study Guide
hth, health, population
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This 13 page Study Guide was uploaded by Kristin Coggins on Tuesday March 1, 2016. The Study Guide belongs to HTH231 at James Madison University taught by Dr. Mary Ott Walter in Winter 2016. Since its upload, it has received 71 views. For similar materials see population health determinents in Health Sciences at James Madison University.


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Date Created: 03/01/16
What is Health? World Health Organization  A state of complete physical, mental, and social well­being and not merely the absence  of disease or infirmity (1948) Medical Perspective  Ensures that a human can maintain a balance ­ physical perspective Sociocultural Perspective  Who you are, where you come from,   Are you able to obtain or achieve or commit to certain obligations that you have based  on the state that you are in at that time Psychological Perspective  Stability, satisfaction, having the ability to cope o PTSD Ottawa Charter for Health Promotion  The process of enabling people to increase control over, and to improve, their health o Complete physical, mental and social well being = Must be able to identify and to  realize aspirations, to satisfy needs, and to change or cope in an environment  7 Dimensions of Health  Emotional: Attentive to feelings, thoughts, behavior  Occupational: Leisure and work time balance  Intellectual: Stimulation activities that expand your knowledge  Physical: Aspects needed to keep your body in top condition   Spiritual: Discovering a set of beliefs and values that brings purpose to your life  Social: Ability to interact w people  Environmental: Overall feelings about the environment What is Public Health?  The science of protecting and improving the health of families and community through  promotion of healthy lifestyles, research for disease and injury prevention and detection  and control of infectious diseases WHat is Population Health?  Health outcomes of a group of individuals, including the distribution of such outcomes  within the group. o Geographical populations  Nations  Communities o Employees o Ethnic Groups o Disables person o Prisoners Measurements of Health Mortality ­ YPLL (Years of Potential Life Loss) The Number of deaths from a particular cause per 100,000 persons  2nd highest risk of dying from non communicable diseases ­ can’t get it from someone  else. Ex. cancer, diabetes  2nd highest death from injuries (firearms)  3rd lowest death from stroke  4th highest incidence rate for cancer  4th highest risk of dying from communicable diseases  Neuropsychiatric conditions  Respiratory Disease  Diabetes  Other endocrine disorders, genitourinary disease, congenital anomalies, infectious  diseases, and perinatal conditions  Highest death rate from transportation­related accidents among the 17 countries  U.S. homicide rate is 6.9 times higher than other high­income countries   Suicide average lower than 16 peer countries  Certain cancer deaths (cervical and colorectal) are lower than most peer countries  Highest incidence of AIDS ­ in high income countries o Almost 9x the OECD average  Infant Mortality Rate o Of 1,000 babies born alive, the number who will die before their first birthday   Maternal Mortality Rate o Of 100,000 women giving birth, the number who will die as a result of  complications during the birthing process Morbidity ­ the diseases and illness, injuries, and disabilities in a population  Prevalence Rate o Number of person who have a particular disease/condition at a given point in  time per 1,000 population  Highest prevalence of o Diabetes o Obesity o Lipid disorders o Asthma  Females o Hypertension o Heart attack/angina o Stroke Life Expectancy ­ number of years, on average, a person born in the year for which the data  are reported is expected to live. Could be based on location / environment   Male: 75.64 (last of the 17 countries)  Female: 80.78 (3rd to last of the 17 countries) Disability­Adjusted Life Year (DALY)  A means of estimating the magnitude of the burden created by a disease/condition that  reduces one’s level of functioning by 50% would mean a loss of .50 DALY  Dying 5 years prematurely would create a loss of the same number of DALY  as living  with a disease for 10 years with a loss of 50% of one’s functional ability Quality­Adjusted Life Year (QUALY)  Evaluate the effectiveness of a specific treatment in prolonging the lives of those with  specific diseases  Estimates the number of years a person’s life is extended by treatment and then  estimates the health related quality of life experienced in those additional years Years of Potential Life Lost  Average age of death in U.S. = 78  Death that occur before 75 (gov’t number) calculate how many more years the person  would have lived had they lived to be 75 Social­ecological Influence:  Determinants of Health:   Broad social, economic, cultural, health, and end environmental conditions and policies  at the global, national, state and local levels  Living and working conditions  Social, family, and community networks  Individual behavior  Innate individual traits: o age, sex, race and biological factors Interventions:  Policies  Programs  Information Outcomes:  Behavioral outcomes   Specific risk factors, diseases, and conditions  Injuries  Well being and health related quality of life  Health equity 5 General Causal Pathways That Link Early Experiences w Later Disease 1. Association between early and adult health conditions results from the persistence of  material, social and cultural conditions over time. 1. Children who grow up in poverty endure poor nutritions, exposure to lead,  allergens, and other pollutants 2. More likely to face poverty and its consequences as adults  b. Biological exposures during early life can produce clinical complications later in life 1. From human papillomavirus to HIV b. Adverse experiences and stimuli can result in biological embedding 1. Nutritional status in utero and during infancy and early childhood can cause  organ damage that is responsible for hypertension, heart disease, metabolic  syndrome, insulin resistance, obesity, and diabetes much later in life b. The field of epigenetics has documented gene­environment interactions 1. Permanent changes in gene expression, triggered by environmental cues, are  thought to precipitate chronic conditions 2. May be inherited by offspring  b. Adversities during childhood and adolescence may cultivate dysfunctional traits,  maladjusted personalities, and susceptibility to antisocial behavior 1. Poor self­control, limited social skills, lack of perseverance and resilience, and  shortsightedness  1. May influence physical activity, diet, and risky behaviors (unprotected  sex) 2. May exacerbate propensities for self­abuse, mental illness, suicide,  violence, unintended pregnancy, obesity, and diabetes Ten Great Public Health Achievements ­ increased life expectancy, decreased mortality rate 1. Vaccinations and Immunizations 1. 1900:  21,064 smallpox cases were reported, and 894 patients died 2. 1920: 469,924 measles cases were reported, and 7,575 patients died;            147,991 diphtheria cases were reported, 13,170 patients died c. Although the smallpox vaccine was developed in 1796, it wasn’t until the 1900s  that its use was widespread enough to fully control the disease 3. Control of Infectious Diseases c. 1900: Leading causes of death ­ pneumonia, tuberculosis, diarrhea and enteritis c. Improvements in sanitation and hygiene, the discovery of antibiotics, and the  implementations of universal childhood vaccination programs have helped, but  the emergence of disease is still unpredictable b. Family Planning 1. Family size declined between 1800 and 1900……. b. Fluoridation of water 1. Decline in tooth decay b. Healthy Mothers and Babies 1. Environmental interventions 2. Advances in clinical medicine 3. Improvements in access to healthcare, surveillance and monitoring of disease,  educational levels, nutrition, and in standards of living b. Motor Vehicle Safety (seat belts, airbags, car seats)  1. 1966: Highway Safety Act and the National Traffic and Motor Vehicle Safety Act 1. Safety features in vehicles 2. Road improvements b. Workplace Safety i. Asbestos, Construction safety, Carcinogens Standards, Chemical Exposure  Safety, Emission Standards exc. b. Safer and healthy foods i. During the early 20th century: Contaminated food, milk, and water caused many  foodborne infections.  ii. Once identified, these could be controlled by hand washing, sanitizing,  refrigeration, pasteurization, pesticide application iii. The rate of infection has declined markedly  b. Tobacco consequences i. Smoking is the leading preventable cause of death and disability in the US  b. Decrease in Heart Disease and Stroke i. Since 1921:  1. Heart disease has been the leading cause of death in the Unites States 2. Stroke has been the 3rd leading cause since 1938 3. Together they account for appoc. 40% of all deaths ii. Since …………………… Life­Course Perspective  Health as a development process influenced by multiple nested social, environmental,  and biological spheres that continually interact over the course of one’s life and shape  the quality and nature of each person’s growth, health, and development  health early in life “lays out the foundation for a lifetime of well­being Causal Pathways  Persistence of material, social, and cultural condition over time  Biological exposures during early life (infectious diseases)  Adverse experiences and stimuli can result in biological embedding  Epigenetics  Adversities during childhood and adolescents may cultivate dysfunctional traits,  maladjusted personalities, and susceptibility to antisocial pathways Determinants ­ explanation for broad patterns of disease in whole groups of people Individual  Tobacco use ­ cigars, pipe, hookah, snuff, chewing, e­cigs o More than 480,000 deaths annually o Second hand smoke causes and estimates 41,000 deaths o Life expectancy for smokers is at least 10 years shorter than for nonsmokers o Quitting smoking before the age of 40 reduces the risk of dying from smoking  related disease by about 90% o Smoking may result in shorter life expectancy for adults 50+, but not for younger  people  Smoking and Pregnancy o Increased risk of miscarriage, low birth weight, and SIDS o Later effects on physical and intellectual development o Neurological problems, problems with certain reading and mathematical skills,  and hyperactivity o Effects are of the same type and magnitude as those reported for “crack babies,”  and many more pregnancy women smoke than use cocaine  Nicotine o Nicotine = a naturally occurring liquid alkaloid that is colorless and volatile o Tolerance and dependence develop quickly o Highly toxic o Typically not delivered fast enough or in a high enough dose to be lethal o Lethal dose = 60 mg (a cigar contains twice that much) o Nicotine replacements ­ no tar or carbon monoxide  patches, gum, nasal spray, inhaler, lozenge  Bupropion (Zyban)  Chantix  Diet o High caloric intake, low energy expenditure; leads to obesity or obesity related  diseases → HBP, high cholesterol, type 2 diabetes, stroke, gallbladder disease,  sleep apnea, depression, anxiety, body pain, difficulty with physical functioning,  osteoarthritis,  o 78.6 million of U.S. adults are obese  BMI <18.5 = underweight   BMI 18.5­24.9 = normal/healthy weight  BMI 25­29.9 = overweight  BMI >30 = obese  Physical inactivity o Difficult to break out from diet o Americans spend 157.9 minutes watching TV or listening to radio > any other  country  Alcohol and other drugs o Moderate alc consumption: 1 for women, 2 for men o 3rd leading preventable cause of death in the US o More than half of Americans aged 12 or older report being current drinkers of  alcohol o Men are more likely to report heavy alcohol use (binge drinking for 5 or more of  the past 30 days) o Binge Drinking: men ­ 5 drinks / women ­ 4 drinks o 7.7% of adults with alc disorder received treatment in the past years  Sexual Practices o US more likely to have sex before 15 compared to Canada, France and the U.K o US more likely to have multiple partners (2 or more past year) o US females less likely to use contraceptive at first or more recent intecourse  compared to France, UK, Sweden o Condom use at first sexual intercourse was lower in U.S. than France, but higher  than Sweden o Condom use at last intercourse was higher in U.S. than any other study country o Dual use (condoms and oral contraceptives) 4% of adolescents females in U.S.  compared to 16% in other countries o Higher rates of pregnancies and STDs among US adolescents o Bacterial Infections  Chlamydia  Gonorrhea  Syphilis o Viral infections   Hepatitis  Herpes (1&2)  HPV ­ can cause cancers due to infections  HIV­ chronic, terminal disease, mom → baby  Injurious Behaviors o Leading cause of death from ages 1­45 o Heavy burden of lifelong neurologic and other disabilities o Unintentional Injuries ­ poison, gas,  o Less likely to fasten front seat belts in US Social & Physical  Social o Availability of resource to meet daily needs o Access to educational, economic, and job opportunities o Access to health care services o Quality of education and job training o Availability of community­based resources in support of community living and  opportunities for recreational and leisure­time activities o Transportation options o Public Safety o Social Support o Social norms and attitudes (discrimination, racism, and distrust of government) o Exposure to crime, violence and social disorder (presence of trash and lack of  cooperation in a community) o Socioeconomic conditions (concentrated poverty and the stressful conditions that accompany it o Residential segregation o Language/literacy o Access to mass media and emerging technologies (cell phones, internet, social  media) o culture o Natural environment, such as green space (trees, grass) or weather o Built environment, such as buildings, sidewalks, bike lanes, and roads o Worksites, schools, and recreational design o Exposure to toxic substances and other physical hazards o Physical barriers, especially for people with disabilities o Aesthetic elements (good lightening, trees, benches)  Social o Availability of resources to meet daily needs o Access to educational, economic, and job opportunities o Access to health care services o Quality of education and job training o Availability of community­based resources in support of community living and  opportunities for recreational and leisure time activities o Transportation options o Public Safety o Social Support  HP 2020 Approach to SHOD o Economic Stability o Education o Social and Community Context o Health and Health Care o Neighborhood and Built Environment  Economic Stability o Poverty o Employment o Food Security o Housing Stability  Education o High School Graduation o Enrollment in Higher Education o Language and Literacy o Early Childhood Education and Development  Social & Community Context o Social Cohesion o Civic Participation o Perceptions of Discrimination and Equity o Incarceration/Institutionalization  Health and Health Care o Access to Health Care o Access to Primary Care o Health Literacy  Neighborhood and Built Environment o Access to Healthy Foods o Quality of Housing o Crime and Violence o Environmental Conditions Biological/Genetic  Age o Need for long­term care is rising  Limited mobility  Frailty or other physical or mental health problem o Effective, community­level primary health care is crucial (HCP not trained in elder care) o Supportive, “age friendly” environments allow older people to live fuller lives and  maximize conditions o Healthy ageing starts early with healthy behaviors o Reinvent assumptions of old age  Sex o Men and women may show diff. symptomology for diseases and conditions o May respond differently to drugs and therapeutics due to physiological and  hormonal differences as well as differences in body composition o Diseases More Common in Men  Prostate Cancer ­ after skin cancer, most common cancer among men  Alport Syndrome ­ kidney problems (carried among x gene)  Red­green color blindness  Hemophilia  Fragile X o Diseases More Common in Women  MS ­ affects CNS   Turner’s Syndrome  Lupus ­ chronic disease  1.5 mil are affects, 90% are women (15­84yo) o Rheumatoid arthritis  causes pain, stiffness, loss of appetite  o Scleroderma  Skin ­ tightening and hardening of patches of skin  Fingers or toes ­ numbness, pain, color changes   Digestive system o Rett Syndrome  1 and 10,000 infants   Emotional and behavioral issues and cognitive defects o Breast Cancer  12.3% of women will be diagnosed with females  Survival rate dependent on when it is found  Stage 4 is most severe ­ much, much lower survival rate  HIV   Female challenges   family care:  dealing with social stigma,   finding access to medical care and treatment  Gynecological care:   Cervical dysplasia (abnormal Pap smear)  Anal/Rectal cervical cancer  Extensive herpes simplex 2  Recurrent yeast infections  Recurrent genital warts  Pregnancy  Tested early  Medications  Additional Issues  Caring for children  Finding appropriate and skilled medical care  Handling relationship issues with your intimate partner (abuse,  financial)  Inherited Conditions o Monogenetic Disorders  Sickle Cell Disease (recessive ­ both parents have to have the gene)  Cell is shaped like a sickle  Deals with dysfunction within red blood cells  More common in African Americans  Symptoms:  Jaundice  Cystic Fibrosis (recessive)  Symptoms:  Salty tasting skin  Male infertility  Wheezing and shortness of breath  Polycystic Kidney Disease (dominant ­ required on one gene)  Tay­Sachs Disease (recessive)  Huntington’s Disease (dominant)  Inherited disease that causes the progressive breakdown of nerve cells in the brain   Impact on a person’s functional abilities and usually results in  movement, thinking (cognitive) and psychiatric disorders  Symptoms before age 20  Movement and Cognitive disorders   Marfan Syndrome (dominant)  Long arms, legs, fingers  Curved spine  Chest stinks in or sticks out  Flat feet  Crowded teeth  Stretch marks not related to weight gain o Multifactorial Inheritance Disorders  Heart Disease  Diabetes  Most Cancers  Behaviors  Alcoholism  Obesity  Mental Illness  Alzheimer’s disease o Chromosome Disorders  Down Syndrome  individual has a full or partial extra copy of a chromosome  1/691 babies in US have DS  Prader­Willi Syndrome  Can never feel full  Leads to obesity  Chronic Myeloid Leukemia o Carrier  One copy of a gene has a change, called a mutation, which causes it to  not work properly.  Still have one working copy of the gene, so they typically do not have any  health problems associated with carrying a mutation.  Many people can be carriers of a disease­causing mutation without even  knowing it.  Increased chance that your child could be born with a genetic disease. Health Services Environmental Policies Health Disparities/Inequality: Systematic differences in health status that occur among  population groups Health inequity:  Those inequalities in health that are deemed unfair or that stem from some  form of injustice Physical Environmental Factors  Air pollution  Proximity to toxic sites   Access to various health­related resources o Healthy or unhealthy food o Recreation resources o Medical care  Community Design  Built Environment o Land use mix o Street community Social Environmental Factors  Safety, violence, and social disorder  Type, quality, and stability or social connections  Social participation  Social cohesion  Social capital  Collective efficacy of the neighborhood (or work) environment Additional Factors  School Environments o Diets o Physical Activity o ATOD Use  Work Environments o Occupational safety o Access to preventive services o Physical work conditions (lead, asbestos, mercury) o Physical demands (carry heavy loads o Ergonomic problems ­ to make positioning more healthy, cushioned mats for jobs that require standing, treadmill desks, sitting on yoga balls o Human Factors (psychosocial)  Ill health  Adverse mental health outcomes  Markers  Residential Segregation  o Violence o Drug Use o Access to firearms What are the possible characteristics of life in America that create certain behaviors or business models?  Dynamism  Rugged Individualism  Are these attributes also associated with risk­taking and potentially unhealthy behaviors?  Is there something unique about how decisions are made in the U.S? Public/Private Sector Policies  Tax policy and decisions by o Employers o Business o Government o Voters  Job growth  Household income  Social mobility  Savings  Spending on Social Services o Significant associations between social spending and   Life expectancy  Infant mortality  PYLL  Possible even mortality  U.S. vs. Them o European  Tax systems more progressive  Child benefits available for parents no matter income  Social programs not restricted to poor  Employment protection is higher  Unemployment benefits are more generous  Labor standards for working parents more extensive


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